Joseph Landesman Minority Report mimvAl BEACH
DIVERSITY STATISTICS REPORTING
'
Name: :s1ser2J\ , 01 -e,S!or1
,
Board / Committee: \\,9 et Akhsory
Appointment Date: l i
Pursuant to City of Miami Beach Ordinance 2009-3632, the City is required to annually
prepare and present a report to the City Commission identifying the City's diversity
statistics. This form allows board and committee applicants and members to voluntarily
self-identify their race, ethnicity, disabled status and gender.
Please check the appropriate box for each category:
Gender: Male Female IZii
Race/Ethnic Categories
What is your race?
rican-American/Black
La Caucasian/White
IZI Asian or Pacific Islander
Native-American/American Indian
IZli Other— Print Race:
Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No"box if not
Spanish, Hispanic, Latino/a.
No
La Yes
Do you consider yourself Physically Disabled?
zir
No
X2I Yes
C:\Users\CENTFraN\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\NP4J9CNX\BC minority
information form 05-20-13 FINAL.doc
Updated: Monday,January 26,2015